Intraoral styloidectomy tomorrow

Hi I’m having my left styloid process removed intra orally tomorrow morning and feeling a little nervous. I’m worried about pain control as I already take PERCOCET 3x a day for back/neck pain due to nerve damage and scar tissue from Chiari Malformation with cranial instability and the surgeries I’ve had to correct it. Can anyone tell me on a scale of 1-10 (lol) how severe their pain was post-op and how long it lasted. I have a freezer full of 40 popsicles just waiting for me !!

Hope that all goes well for you Daisy! I had external surgery so can’t comment about the recovery from intr-oral personally, but you can search the discussions using the magnifying glass icon. I’ve also read that it’s supposed to be similar to having a tonsillectomy as an adult, you can google recovery from that & get lots of info.
Thinking of you & let us know how you get on.

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Hi Daisy 1967!

Because of anesthesia, anti-inflammatory & pain meds used during surgery it can be hours or even a day before your pain will escalate to its full potential. I had external surgery so can only speak to my experiences there but icing my neck 3-5x/day 15 min at a time was very helpful. My doctor also prescribed prednisone post op to help limit swelling & of course, Percocet for pain. The Percocet you’re already taking should help manage your post op pain, but you may need to take it more often. My surgeon recommended 1 Percocet tab every 4 hrs post op to keep the pain from getting ahold. The bigger issue is the inflammation which will make it hard to swallow at first. Popsicles will likely help w/ that as will ice.

As far as a pain scale goes, I was so dopey from the Percocet I’m not sure I ever thought about how bad my pain was. I’d say though that when I started cutting back on Percocet (way too early, BTW) on day 3 post op, my pain the following day was probably at a 7-8. Prior to that maybe a 4. Each of us is different & obviously has a different level of tolerance for pain so this is a subjective opinion on my part.

I hope this is helpful & I will put you on my calendar for tomorrow morning to remind me to pray for you during your surgery. May it go perfectly with quick healing for you.

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I had both styloids removed intraorally at the same time. I had an excellent surgeon. I did not have much pain, but I was very dillegent about taking pain medication on a strict schedule. Get liquid pain medication for the first 4 to 5 days. The doctor did not remove my tonsils, which helped. My biggest issue was swelling. Immediate post-op was a big challenge because of the swelling and a bad post-op nurse who was not prepared to elevate my head so I could breath. I ended up staying in the hospital overnight for injectable pain medication and steroids to bring the swelling down. By morning, I was much better. Have some one with you in post op who is prepared to speak for you until swelling goes down. Keep your head elevated, use ice packs, even in post-op, to bring swelling down as quickly as possible. Broth was the only thing I could eat for about 2 weeks, and it took another 2 weeks for swelling to subside completely. Since you are doing only one styloid, you should not be as swollen as as I was. Good luck!

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I should also remove both my styloids but I am still looking for a surgeon in Italy. I would like to do it intraorally but I am not fully aware of the pros and the cons with respect to external surgery. Moreover, I do not know if doctors are usually speciliazed in one kind of surgery or if they adapt the techniques to your case. I have still a lot of owrk to do!
Good luck to you in any case.

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External surgery allows for monitoring of the nerves in that area of the neck during surgery & more of the styloid process to be removed (all the way back to the skull base) & also allows for the stylo-hyoid ligaments to be removed. Intraoral surgery occurs in a more limited space so the styloid process can only be shortened not completely removed & I’m not sure about the accessibility of the s-h ligament intraorally. There isn’t a good way to monitor the nerves when going through the throat. Most doctors who do external surgery are careful to make their incisions along the lines of natural neck creases so the scars are basically invisible once the incisions are healed.
Surgeons who do ES surgeries generally have a preferred technique (either intra-oral or external) & don’t adapt their method of approach to each specific case.

There’s info in the Newbies Guide section under surgery, but basically there’s more likelihood of an infection with intra-oral, & less visibility to the styloid, so they can’t often get as much of the styloid removed. External gives better access- sometimes scarring but as Isaiah says, usually its done in the fold of the neck so can’t be seen.
You mention that you need both sides done- they can be done at the same time, but most doctors don’t like to do that as there can be a lot of swelling, so prefer to do 2 ops.

Dear Isaiah,
Many thanks for your clear advice. I hope to find a good doctor anyway and to put my health in his hands. In am trying to do it in Italy, if possible, as all the expenses are covered by the national health system. I am still searching but I have some preliminary information about some doctors.
Best wishes

Dear Jules,
Many thanks too for your useful complementary information.
Best wishes

It’s good to hear you have some leads on good surgeons. Having surgery near your home is always best. I’ll be praying for you to wisely choose the right surgeon.

Many thanks. Since you are an expert, do you know if there are possible complications in the case of a “fragmented” styloid. The left one (4 cm) is compact whereas the right one (5.3 cm) is defined through CT as fragmented.

Obviously having more pieces gives potential for them to cause inflammation or damage to nerves etc. in the area, so this can cause ES symptoms the same as an elongated styloid process. I would think that a skilled surgeon should be able to remove them okay, but if it was me I’d definitely opt for external surgery in that case as they would need more visibility to remove the pieces properly. Don’t be fobbed off that it’s okay if it’s in pieces either as they definitely do cause problems- some doctors think if they break the styloids then it won’t cause problems!

I’ll add to what Jules said to clarify a bit - some doctors think that breaking the styloids into little pieces (which can be done w/o surgery) & leaving them in the body is the solution to Eagle Syndrome. IT IS NOT!! It can actually cause worse problems. I totally agree w/ her that external surgery would be best in the case of your fragmented styloid as intraoral surgery won’t give the surgeon good access to all the pieces so they can be removed. The surgery itself shouldn’t be any more complicated for a broken styloid than for an intact one. Often a surgeon has to break an intact styloid & remove it piece by piece if the nerves or vascular tissues are really wrapped around it.

Many thanks to both of you. You suggestions seem deep and wise. I found that in Eminia-Romagna, an Italian region, there are some specialists in external surgery working at public hospitals. See for instance:

I will try to contact them.
Best wishes

p.s. Emilia Romagna, sorry, even if this doctor, Vincenzo Clabrese, did this performance at the Ragusa Hospital, Sicily. Now he works at Rimini, Romagna.

That’s a good find, I hope that maybe he can help you.

Yes, thank you and other Italians with ES too. Calabresi and Vicini seem to the best doctors in Italy for ES.

I second Jules comment and am so glad your research has paid off for you. Please let us know if you see Dr. Clabrese & if so, how your appointment goes. It would be fantastic for you to be able to get surgery without too much delay.

Thank you. I am not a surgeon nor a doctor but Dr Calabrese seems to have a “golden hand.” I will try to contact him.
Best wishes

Please,keep in touch,we are hoping that you can recommend your doctor in the future, so other Italians who visit this site will be able to find a doctor. Good luck. I just had an external surgery
2 weeks ago. I am still recovering,but now I can sleep at night without pain.